门诊精神分裂症患者服药依从性评定及血药浓度检测的意义

Clinical significance of monitoring plasma levels of antipsychotics in the outpatients with schizophrenia

目的 探讨血药浓度检测对评定门诊精神分裂症患者对抗精神病药依从性 (以下简称依从性 )的意义。方法 对 718例单一服用氯丙嗪、奋乃静、氯氮平或氟哌啶醇的门诊精神分裂症患者评定依从性。于入组第 2周末和第 3个月末分别测定患者的血药浓度 ,研究时间为 3个月。结果服用氯氮平或奋乃静患者的依从性好于服用氯丙嗪和氟哌啶醇者 ,不依从率分别为 5 4% ,10 5 % ,19 5 %和 2 1 1%。服用氯丙嗪、奋乃静或氯氮平者在用药剂量接近时 ,完全依从组的血药浓度[(380± 12 0 ) μg/L ,(2 48± 15 2 ) μg/L ,(35 8± 119) μg/L]高于部分依从组 [(32 5± 10 9) μg/L ,(2 0 9± 148)μg/L,(317± 111) μg/L]及不依从组 [(2 6 4± 10 3) μg/L ,(12 3± 117) μg/L ,(2 5 5± 12 6 ) μg/L],部分依从组的血药浓度高于不依从组 (t检验 ,P <0 0 5～ 0 0 1)。完全依从组的药物剂量与血药浓度呈正相关(Pearson检验 ,P <0 0 5 )。服用氟哌啶醇者未显示上述结果。第 2周末与第 3个月末对患者的血药浓度检测结果相仿。结论 血药浓度检测对判断患者的依从性有辅助价值。

Objective The goal of this study was to explore the relationship between compliance and plasma levels of antipsychotics in the outpatients with schizophrenia Methods The compliance was assessed in 718 outpatients with schizophrenia who took one of those antipsychotics (chlorpromazine, perphenazine, clozapine or haloperidol) The plasma levels of antipsychotics in these patients were measured after two weeks and three months of treatment Results The compliance of patients who took clozapine or perphenazine was better than that who took chlorpromazine or haloperidol The rates of non compliance were as following: 5 4%, 10 5%, 19 5%, and 21 1% When the patients took similar doses of those antipsychotics (chlorpromazine, perphenazine or clozapine), the plasma levels of antipsychotics in complete compliance patients [chlorpromazine (380±120) μg/L ,perphenazine (248±152) μg/L,and clozapine (358±119) μg/L, respectively] were higher than that in incomplete compliance patients [(325±109)μg/L,(209±148)μg/L,and(317±111)μg/L, respectively] and non compliance patients [(264±103)μg/L,(123±117)μg/L,and(255±126)μg/L, respectively] The plasma levels of antipsychotics in incomplete compliance patients were higher than that in non compliance patients ( P <0 05～ 0 01) Furthermore, the significant correlation between doses and plasma levels of antipsychotics in the patients who took chlorpromazine, perphenazine and clozapine but not of haloperidol was found in the complete compliance patients ( P <0 05) Conclusion It is helpful to discriminate the compliance of patients with schizophrenia by monitoring their plasma levels of antipsychotics